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Ситуационные задачи по неврологии на английском
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Дата добавления :18.03.2023, 21:49
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1) A 58-year-old male presents with sudden onset right-sided weakness and slurred speech. On examination, he has a left hemiparesis with a dense right-sided facial droop. His speech is dysarthric, and he has difficulty understanding spoken language. What is the most likely diagnosis, and what imaging modality is best to confirm it?
Answer 1:
The most likely diagnosis is a stroke involving the left middle cerebral artery territory. The dense right-sided facial droop suggests involvement of the facial motor cortex, which is typically located in the precentral gyrus of the left hemisphere. The dysarthria and difficulty understanding spoken language suggest involvement of the left hemisphere language areas, which are typically located in the posterior superior temporal gyrus (Wernicke's area) and the inferior frontal gyrus (Broca's area). An ischemic stroke is the most likely cause, but a hemorrhagic stroke is also possible.
The best imaging modality to confirm the diagnosis is an urgent non-contrast CT scan of the brain, followed by a CT angiogram or MRI/MRA to assess the underlying cause of the stroke, such as a thromboembolic source or an underlying structural abnormality.
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Дата добавления :18.03.2023, 21:49
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A 32-year-old female presents with recurrent headaches and visual disturbances. On examination, she has bilateral papilledema and an enlarged blind spot on visual field testing. She also reports pulsatile tinnitus and a whooshing sound in her ear. What is the most likely diagnosis, and what imaging modality is best to confirm it?
Answer 2:
The most likely diagnosis is idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri. IIH is a condition characterized by increased intracranial pressure without a known underlying cause. The symptoms typically include headaches, visual disturbances, and pulsatile tinnitus, among others. Bilateral papilledema and an enlarged blind spot on visual field testing are characteristic findings on examination.
The best imaging modality to confirm the diagnosis is magnetic resonance venography (MRV), which can assess the cerebral venous outflow and rule out venous sinus thrombosis or stenosis. A CT scan can also be useful to assess for any other underlying causes of increased intracranial pressure, such as a mass lesion or hydrocephalus.
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Дата добавления :18.03.2023, 22:46
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A 60-year-old man presents with symptoms of weakness and numbness in his left leg. What is the likely location of the lesion? What diagnostic test would you perform to confirm your suspicion?
Answer: The likely location of the lesion is the right cerebral hemisphere, which controls the left side of the body. A magnetic resonance imaging (MRI) scan of the brain would confirm this suspicion.
Explanation: The symptoms of weakness and numbness in the left leg suggest a problem with the right cerebral hemisphere, which controls the left side of the body. An MRI scan of the brain is the most effective diagnostic test for identifying the location of the lesion.
A 35-year-old woman presents with symptoms of tremors, rigidity, and bradykinesia. What is the likely diagnosis, and what treatment would you recommend?
Answer: The likely diagnosis is Parkinson's disease. Treatment with levodopa and carbidopa is recommended.
Explanation: The symptoms of tremors, rigidity, and bradykinesia are characteristic of Parkinson's disease, a neurodegenerative disorder that affects the dopamine-producing neurons in the brain. Treatment with levodopa and carbidopa is recommended to increase dopamine levels and improve motor function.
A 50-year-old man presents with symptoms of sudden onset of severe headache, nausea, and vomiting. What is the likely diagnosis, and what diagnostic test would you perform to confirm your suspicion?
Answer: The likely diagnosis is a subarachnoid hemorrhage. A computed tomography (CT) scan of the brain is the diagnostic test of choice to confirm this suspicion.
Explanation: The sudden onset of severe headache, nausea, and vomiting are characteristic symptoms of a subarachnoid hemorrhage, a medical emergency caused by bleeding in the space between the brain and the tissues that cover it. A CT scan of the brain is the most effective diagnostic test for identifying a subarachnoid hemorrhage.
A 25-year-old woman presents with symptoms of weakness and atrophy in her hands and difficulty swallowing. What is the likely diagnosis, and what diagnostic test would you perform to confirm your suspicion?
Answer: The likely diagnosis is amyotrophic lateral sclerosis (ALS). Electromyography (EMG) is the diagnostic test of choice to confirm this suspicion.
Explanation: The symptoms of weakness and atrophy in the hands and difficulty swallowing are characteristic of ALS, a neurodegenerative disorder that affects the motor neurons in the brain and spinal cord. EMG is the most effective diagnostic test for identifying the motor neuron dysfunction associated with ALS.
A 40-year-old man presents with symptoms of episodic weakness and sensory disturbances in his arms and legs. What is the likely diagnosis, and what diagnostic test would you perform to confirm your suspicion?
Answer: The likely diagnosis is multiple sclerosis (MS). A magnetic resonance imaging (MRI) scan of the brain and spinal cord is the diagnostic test of choice to confirm this suspicion.
Explanation: The symptoms of episodic weakness and sensory disturbances in the arms and legs are characteristic of MS, a chronic autoimmune disorder that affects the central nervous system. An MRI scan of the brain and spinal cord is the most effective diagnostic test for identifying the characteristic lesions associated with MS.
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Дата добавления :18.03.2023, 23:23
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A patient presents with symptoms of acute stroke, including sudden onset of weakness on one side of the body, difficulty speaking, and a severe headache. What is the most appropriate initial imaging study, and what is the likely diagnosis?
Answer: The most appropriate initial imaging study is a non-contrast CT scan of the head. The likely diagnosis is ischemic stroke, which occurs when there is a blockage in a blood vessel in the brain, leading to decreased blood flow and oxygen to the affected area.Explanation: A non-contrast CT scan is the preferred initial imaging study for acute stroke because it can quickly identify any bleeding in the brain that would require urgent intervention. Ischemic stroke is the most common type of stroke and occurs when a blood clot or other blockage forms in a blood vessel in the brain.A patient with a history of migraines presents with new onset of visual symptoms, including flashing lights and zigzag lines, followed by a headache. What is the likely diagnosis, and what additional testing may be necessary?
Answer: The likely diagnosis is an ocular migraine, also known as a migraine with aura. Additional testing may include a visual field exam and an ophthalmologic evaluation to rule out any other underlying eye conditions.Explanation: Ocular migraines are a type of migraine headache that involves visual disturbances, such as flashing lights, zigzag lines, or blind spots, followed by a headache. They typically do not cause any lasting damage to the eyes or vision, but other underlying eye conditions can also cause similar symptoms, so additional testing may be necessary.A patient with Parkinson's disease presents with worsening tremors and difficulty with movement. What medication may be used to manage these symptoms, and how does it work?
Answer: Levodopa is a medication that may be used to manage the symptoms of Parkinson's disease. It works by increasing the levels of dopamine in the brain, which helps to improve movement and reduce tremors.Explanation: Parkinson's disease is a neurodegenerative disorder that affects the dopamine-producing neurons in the brain. Levodopa is a medication that is converted into dopamine in the brain, helping to compensate for the loss of dopamine-producing neurons and improve symptoms.A patient with multiple sclerosis presents with a relapse of symptoms, including weakness, numbness, and difficulty with coordination. What medication may be used to manage the relapse, and how does it work?
Answer: Methylprednisolone is a medication that may be used to manage the relapse of symptoms in multiple sclerosis. It works by reducing inflammation in the brain and spinal cord, which helps to reduce the severity and duration of the relapse.Explanation: Multiple sclerosis is an autoimmune disorder that affects the myelin sheath, the protective covering around nerve fibers in the brain and spinal cord. Methylprednisolone is a corticosteroid medication that helps to reduce inflammation and the immune response that contributes to the damage of the myelin sheath.A patient with epilepsy presents with frequent seizures that are not well-controlled with medication. What surgical procedure may be considered as a treatment option, and how does it work?
Answer: A temporal lobectomy is a surgical procedure that may be considered as a treatment option for epilepsy that is not well-controlled with medication. It involves removing the portion of the temporal lobe that is causing the seizures, which can help to reduce the frequency and severity of seizures.Explanation: Temporal lobectomy is a surgical procedure that is performed when seizures are originating from a specific area of the brain, such as the temporal lobe. By removing the portion of the brain that is causing the seizures, it can help to reduce the frequency and severity of seizures and improve the patient's quality of life. This procedure is typically reserved for patients
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Дата добавления :18.03.2023, 23:25
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Situational task 1:
A 55-year-old woman presents with a sudden onset of weakness in her left arm and leg. She also has difficulty speaking and understanding speech. On examination, there is weakness in the left arm and leg, and the speech is slurred. What is the most likely diagnosis, and what imaging study should be ordered?
Answer:
The most likely diagnosis is a stroke, specifically an ischemic stroke affecting the right side of the brain. An MRI with diffusion-weighted imaging (DWI) should be ordered to confirm the diagnosis. DWI is more sensitive than a CT scan in detecting early ischemic changes in the brain.
Explanation:
The sudden onset of weakness and difficulty speaking are classic symptoms of a stroke, which is a neurological emergency. In this case, the symptoms suggest a right-sided stroke, which would cause weakness on the left side of the body and speech difficulties. MRI with DWI is the imaging study of choice in the acute setting because it is more sensitive than CT in detecting early ischemic changes in the brain. Early diagnosis and treatment are crucial in stroke management to minimize brain damage and improve outcomes.
Situational task 2:
A 70-year-old man presents with a 6-month history of memory loss, confusion, and difficulty with daily activities. On examination, there is evidence of cognitive impairment and gait instability. What is the most likely diagnosis, and what imaging study should be ordered?
Answer:
The most likely diagnosis is Alzheimer's disease, and an MRI with T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences should be ordered to evaluate for brain atrophy.
Explanation:
The history of progressive cognitive decline and gait instability is consistent with Alzheimer's disease, which is a common cause of dementia in the elderly. An MRI with T1-weighted, T2-weighted, and FLAIR sequences is the preferred imaging modality for evaluating brain atrophy and ruling out other causes of dementia, such as vascular dementia or frontotemporal dementia.
Situational task 3:
A 25-year-old woman presents with a 3-day history of severe headache, nausea, and vomiting. On examination, there is evidence of papilledema, and a CT scan of the head shows hydrocephalus with enlargement of the ventricles. What is the most likely diagnosis, and what imaging study should be ordered?
Answer:
The most likely diagnosis is obstructive hydrocephalus, and an MRI with T1-weighted and T2-weighted sequences should be ordered to determine the cause of the obstruction.
Explanation:
The symptoms of severe headache, nausea, vomiting, and papilledema suggest increased intracranial pressure, which is commonly caused by obstructive hydrocephalus. A CT scan can confirm the presence of hydrocephalus but may not identify the underlying cause. MRI with T1-weighted and T2-weighted sequences is the imaging study of choice for evaluating the cause of hydrocephalus, such as a tumor or cyst blocking the flow of cerebrospinal fluid.
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Дата добавления :18.03.2023, 23:26
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A 60-year-old male patient presents to the emergency room with sudden onset weakness of the right side of the body. On examination, there is right hemiparesis and mild facial droop. The initial CT scan of the brain is normal. What is the most likely diagnosis and what is the next step in management?
Answer: The most likely diagnosis is acute ischemic stroke. The next step in management is to obtain an urgent MRI of the brain and consider thrombolytic therapy if the patient is eligible.
Explanation: The presentation of sudden onset weakness of one side of the body with facial droop is classic for a stroke. However, initial CT scans can be normal in the early stages of a stroke. An MRI is more sensitive and can pick up early changes in the brain. Thrombolytic therapy can be given to eligible patients within 4.5 hours of symptom onset to improve outcomes.
A 25-year-old female presents with a 6-month history of worsening headaches and visual disturbances. On examination, there is bitemporal hemianopsia. The MRI shows a pituitary adenoma. What is the most likely diagnosis and what is the next step in management?
Answer: The most likely diagnosis is a pituitary adenoma causing compression of the optic chiasm. The next step in management is surgical resection of the adenoma.
Explanation: Pituitary adenomas are benign tumors that can cause compression of the optic chiasm, leading to visual disturbances such as bitemporal hemianopsia. Surgical resection is the mainstay of treatment and can lead to significant improvement in symptoms.
A 40-year-old male presents with sudden onset headache, vomiting, and altered mental status. On examination, there is nuchal rigidity and photophobia. The CT scan of the brain shows subarachnoid hemorrhage. What is the most likely cause and what is the next step in management?
Answer: The most likely cause is a ruptured intracranial aneurysm. The next step in management is to obtain a cerebral angiogram to identify the location of the aneurysm and plan for surgical or endovascular treatment.
Explanation: Subarachnoid hemorrhage is most commonly caused by the rupture of an intracranial aneurysm. A cerebral angiogram is the gold standard for identifying the location and size of the aneurysm. Treatment options include surgical clipping or endovascular coiling to prevent rebleeding and improve outcomes.
A 60-year-old female presents with a 1-year history of progressive cognitive decline, personality changes, and memory loss. On examination, there are signs of frontal lobe dysfunction. The MRI of the brain shows diffuse cortical atrophy. What is the most likely diagnosis and what is the next step in management?
Answer: The most likely diagnosis is frontotemporal dementia. The next step in management is to provide supportive care and consider symptomatic treatment with cholinesterase inhibitors.
Explanation: Frontotemporal dementia is a type of dementia that primarily affects the frontal and temporal lobes of the brain, leading to personality changes, language difficulties, and executive dysfunction. There is no curative treatment for this condition, and management is mainly supportive. Symptomatic treatment with cholinesterase inhibitors may help to improve cognition and behavioral symptoms.
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Дата добавления :18.03.2023, 23:28
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A patient presents with sudden onset weakness of their right arm and leg. On examination, there is spasticity and hyperreflexia on the right side. What is the likely diagnosis, and what is the most appropriate imaging modality to confirm it?
Answer: The likely diagnosis is a stroke, specifically an ischemic stroke in the left middle cerebral artery territory. The most appropriate imaging modality to confirm this would be an urgent brain MRI with diffusion-weighted imaging (DWI) sequence, as this is the most sensitive imaging test for detecting acute ischemic stroke.Explanation: Ischemic stroke is a common cause of sudden onset weakness on one side of the body. Spasticity and hyperreflexia are signs of upper motor neuron involvement, which is consistent with a stroke affecting the corticospinal tract in the left hemisphere. DWI is the most sensitive imaging sequence for detecting acute ischemic stroke, as it is able to detect changes in water diffusion in the affected brain tissue within minutes of the onset of symptoms.A patient presents with a 6-month history of slowly progressive muscle weakness and atrophy in the hands, arms, and shoulders. On examination, there is weakness in the biceps, triceps, and deltoids, with preserved hand grip strength. The patient also has fasciculations in the affected muscles. What is the likely diagnosis, and what is the most appropriate initial test to confirm it?
Answer: The likely diagnosis is amyotrophic lateral sclerosis (ALS). The most appropriate initial test to confirm it is electromyography (EMG) and nerve conduction studies (NCS).Explanation: ALS is a progressive neurodegenerative disease that affects the upper and lower motor neurons. The clinical features of muscle weakness and atrophy, fasciculations, and selective involvement of certain muscle groups are highly suggestive of ALS. EMG and NCS can detect abnormal electrical activity in the affected muscles and confirm the diagnosis of ALS.A patient presents with a 2-day history of severe headache and neck stiffness. On examination, there is photophobia, nuchal rigidity, and positive Kernig's sign. What is the likely diagnosis, and what is the most appropriate test to confirm it?
Answer: The likely diagnosis is meningitis. The most appropriate test to confirm it is a lumbar puncture.Explanation: Meningitis is an infection of the meninges, which can cause symptoms such as headache, neck stiffness, and photophobia. Kernig's sign, which is the inability to straighten the leg when the hip is flexed at a right angle, is a sign of meningeal irritation. A lumbar puncture is the most appropriate test to confirm the diagnosis of meningitis, as it can detect the presence of abnormal cells and elevated levels of protein and glucose in the cerebrospinal fluid.
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